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At least 55 records · Page 3Linked to original sources

Use of the Herbert bone screw for scaphoid nonunions.

The Herbert bone screw was used to treat 22 selected patients with established scaphoid nonunions. The indications for its use included evidence of avascular necrosis, proximal third fracture fragment, previous bone graft, fracture angulation or displacement, and a bipartite scaphoid. Treatment resulted in radiographic and clinical evidence of healing in 16 patients; 4 patients were symptom-free, but had incomplete healing as evidenced by radiograph; and 2 patients had persistent symptoms with radiographic evidence of nonunion.

Adolescent↗

The Herbert bone screw and its applications in foot surgery.

The author presents multiple indications of the Herbert bone screw in foot surgery. Both cannulated and noncannulated systems are discussed along with operative steps for several of the more common procedures performed by the author with this type screw. The Herbert bone screw systems provide another alternative for internal fixation to the surgeon.

Ankle↗

Effect of laser shock peening on fatigue life and surface characteristics of stainless steel cortical bone screws.

OBJECTIVE: To investigate the effect of laser shock peening on the fatigue life and surface characteristics of 3.5-mm-diameter cortical bone screws. SAMPLE POPULATION: 32 stainless steel, 3.5-mm-diameter cortical bone screws. PROCEDURE: Screws were randomly assigned to an untreated control group or 2 power-density treatment groups, 6 gigawatts (GW)/cm2 and 8.5 GW/cm2, for laser shock peening. Number of cycles to failure and findings on scanning electron microscopy-assisted morphometric evaluation, including the mode of failure, surface debris, surface damage, and thread deformation, were compared between control and treated screws. RESULTS: The 6 GW/cm2 treated screws had a significant (11%) improvement in fatigue life, compared with untreated control screws. The 8.5 GW/cm2 treated screws had a significant (20%) decrease in fatigue life, compared with control screws. A mild but significant increase in thread deformation was evident in all treated screws, compared with control screws. The 8.5 GW/cm2 treated screws had significantly more surface irregularities (elevations and pits), compared with control or 6 GW/cm2 treated screws. CONCLUSION AND CLINICAL RELEVANCE: A modest positive increase in fatigue strength was produced by this design of laser shock peening on the midshaft of cortical bone screws. High laser shock peening power densities were detrimental, decreasing screw fatigue strength probably resulting from structural damage. Greater fatigue life of cortical bone screws can be generated with laser shock peening and could reduce screw breakage as a cause of implant failure; however, future studies will be necessary to address biocompatibility, alternative cleaning techniques, alterations in screw strength and pullout characteristics, and effects on susceptibility to corrosion.

Analysis of Variance↗

Bone-screw mandible fixation: an intraoperative alternative to arch bars.

OBJECTIVES: Bone-screw mandible fixation (BSMF) is evaluated as an alternative to intraoperative arch-bar maxillomandibular fixation before plating of mandibular fractures. BSMF is achieved by wire ligation of opposing bone-screws placed in the maxilla and mandible. METHODS: A retrospective evaluation of 23 patients with 40 mandibular fractures who underwent mandibular fracture repairs. BSMF was used instead of arch bars to ensure proper dental occlusion. All fractures were then plated, after which BSMF was removed before termination of anesthesia. RESULTS: Normal occlusion was observed in 21 patients (91.3%), Class II malocclusion was noted in 1 patient (4. 3%), and 1 patient was edentulous. No complications related to the use of BSMF were observed. CONCLUSION: BSMF can serve as a viable alternative to arch-bar maxillomandibular fixation for obtaining temporary intraoperative occlusion. BSMF produces acceptable malocclusion rates and offers the advantages of decreased intraoperative time, lower risk for percutaneous and mucosal wire punctures, and ease of use.

Accidents, Occupational↗

Midshaft clavicular non-unions treated with the Herbert cannulated bone screw.

PURPOSE: To assess an alternative technique for the treatment of midshaft non-unions of the clavicle. METHODS: Five patients with symptomatic non-unions of the clavicle were treated with open reduction and intramedullary fixation by using a Herbert cannulated bone screw. Autogenous bone grafting was applied in one case and decortication in the other 4 cases. RESULTS: Review of the clinical and radiological documentation at a mean time of 13 months (range, 9-26 months) postoperatively shows that union was achieved in all 5 cases. There were no complications related to the operation, and no patient needed removal of the implant for protrusion, loosening, or any other cause. CONCLUSION: Midshaft non-unions of the clavicle can be treated successfully using the Herbert cannulated bone screw, which avoids the need for a second operation to remove the implant after bone union.

Adolescent↗

Results of intraoral cortical bone screw fixation technique for mandibular fractures.

The intraoral cortical bone screw fixation technique carries many advantages over traditional methods of intermaxillary fixation. Simplicity of the technique, reduction of operative time, and reduction of risk of transmission of human immunodeficiency virus and hepatitis make this an important technique in the armamentarium of busy facial trauma surgeons. Since 1992, 45 mandibular fractures in 29 patients treated with the intraoral cortical bone screw technique for intermaxillary fixation were retrospectively analyzed. At our institution, this technique has become the workhorse method of repairing most mandibular fractures and is associated with minimal complications.

Adolescent↗

[Accuracy of fluoroscopic navigation of pedicle screws. CT-based evaluation of bone screw placement].

While the advantages of C-arm navigation in computer-assisted spine surgery are obvious, the accuracy of pedicle screw placement with virtual fluoroscopy still needs to be verified. The C-arm-based ION system (Medtronic Sofamor Danek) was used to navigate pedicle screw insertion in patients undergoing spinal surgery for various conditions. In a prospective study, a total of 160 screws were inserted in the first 30 consecutive patients since introduction of the system at our institution: 54 at the thoracic spine (highest level: TH4) and 106 at the lumbar spine. Computed tomography (CT) scans were performed postoperatively by two independent radiologists to control the accuracy of screw placement at the level of the pedicles after reconstruction of axial images according to Laine et al. The comparison of the calculated accuracy rate of pedicle screw placement using virtual fluoroscopy with reported results achieved with CT-based navigation shows similar results for virtual fluoroscopy and a remarkable increase of accuracy in comparison to reports on conventional pedicle screw placement.

Bone Screws↗

The effect of surface material and roughness on bone screw stability.

OBJECTIVE: To evaluate the effects of osteointegration ability and surface texture on bone screw interface stability in three different groups of titanium screws. DESIGN: Sixty titanium tapered screws were used: twenty screws were polished, uncoated (Group A); twenty screws were rough, coated with titanium (Group B); and twenty screws were rough, coated with fluor-hydroxyapatite (Group C). Thirty screws, ten per group, were implanted in the femurs and tibiae of two sheep, which were euthanized one month after surgery. The remaining thirty screws, ten per group, were implanted in the femurs and tibiae of another two sheep, which were euthanized three months after surgery. RESULTS: At one month, extraction torque of Group C was higher than that of Group A (p = 0.042). At three months, extraction torque of Group C was higher than that of Group A (p < 0.0001) and Group B (p < 0.0001). At three months, extraction torque of Group C was higher compared with the corresponding insertion torque (p < 0.0001) and compared with the corresponding extraction torque at one month (p < 0.0001). At one and three months, a high percentage of bone-screw contact was observed histologically in Groups B and C. A continuous gap with fibrous tissue encapsulation was observed in Group A. CONCLUSIONS: This study shows that the osteointegration ability provided by the type of coating is a very important parameter for optimizing the bone-screw stability. Surface texture is also important. By using screws with optimal osteointegration ability, very positive clinical consequences can be expected.

Animals↗

A comparative study of wire osteosynthesis versus bone screws in the treatment of mandibular prognathism.

In sagittal split osteotomies as well as in vertical osteotomies for reduction of the mandible, wire and bone screw osteosynthesis has been used in the Department of Oral and Maxillofacial Surgery of the University of Erlangen-Nuremberg within the last few years in a total of 221 cases of mandibular prognathism. In about one half of these cases a conventional wire osteosynthesis was performed, and in the other half a stable osteosynthesis with bone screws was used. One hundred twenty-one cases could be included in a follow-up study, and a true comparison could be made between the two methods. The results of our study were quite interesting: There were no signs of an increase in temporomandibular joint problems when the bone screw technique was used. However, slightly more alterations in the mandibular nerve were found. The relapse tendency, on the other hand, was minimal in cases in which bone screws were applied, in comparison with those in which wire osteosynthesis was used.

Bone Screws↗

The Herbert cannulated bone screw in rearfoot arthrodesis.

Herbert 4.5- and 6.5-mm. cannulated bone screws were used to fixate nine talocalcaneal and six talonavicular arthrodeses in 12 patients in 2 years. All arthrodesis sites were clinically and radiographically fused within 8 to 12 weeks of operation. The authors describe proper use of the Herbert cannulated bone screw and discuss its advantages and limitations, compared with those of the traditional lag screw in rearfoot arthrodesis.

Adolescent↗

Use of the Herbert bone screw in surgery of the wrist.

The Herbert bone screw is a new device, designed to produce compression and rigid fixation of small cancellous bone fragments. Being completely buried within the bone, it may be introduced through the articular surface of the joint. A second operation to remove the implant is not required. Although originally developed for fixation of scaphoid fractures, its use has been extended to other carpal bones and small joint fusions in the hand and wrist. The author's experience with this technique shows that excellent results may be achieved when rigid internal fixation allows for early mobilization of the wrist and hand.

Bone Screws↗

The Herbert bone screw: a ten year perspective.

It is now over ten years since the Herbert bone screw was first released in Australia. In 1984, Herbert and Fisher first published their experience with the use of this new bone screw in the management of scaphoid fractures. Since that time, there has been a growing interest in the technique and over 60 articles have appeared in the English literature. The purpose of this paper is to review and comment on the relevant publications as they relate to the biomechanical properties of the screw, to its use in the management of scaphoid fractures and to other applications in surgery of the hand.

Biomechanical Phenomena↗

Proximal interphalangeal joint arthrodesis in 34 horses using two parallel 5.5-mm cortical bone screws.

OBJECTIVE: To report clinical experience with arthrodesis of the proximal interphalangeal joint in horses using two parallel 5.5-mm cortical bone screws placed in lag fashion. STUDY DESIGN: Retrospective, clinical study. ANIMALS: Thirty-four horses, aged 1 to 19 years. METHODS: Medical records for all horses admitted (1991-1997) for pastern arthrodesis using two 5.5-mm ASIF cortical bone screws, in parallel orientation, and placed in lag fashion by use of a combined aiming device to facilitate accuracy were reviewed. Signalment, lameness diagnosis, duration of lameness, limb(s) involved, and outcome were recorded. Criteria for successful outcome were determined as return to previous level of function or future intended athletic use. RESULTS: Thirty-nine proximal interphalangeal joint arthrodeses were performed on 34 horses. One horse was euthanatized in the recovery room and was excluded from data analysis. Successful outcome occurred in 85% of frontlimbs and 89% of hindlimbs. Failure occurred in 5 joints; 1 horse had lameness directly associated with surgery, whereas 4 horses had unrelated lameness. CONCLUSION AND CLINICAL RELEVANCE: Age, breed, and initial disease did not affect outcome. Arthrodesis of the proximal interphalangeal joint by use of two 5.5-mm ASIF cortical bone screws, in parallel orientation, placed in lag fashion by use of a combined aiming device, resulted in sound use of the limb in >85% of the joints with shortened postoperative coaptation.

Animals↗

An audit of mandibular fractures treated by intermaxillary fixation using intraoral cortical bone screws.

INTRODUCTION: During the last 10 years, intermaxillary fixation using intraoral cortical bone screws has been introduced for the treatment of mandibular fractures. The aim of this work was to evaluate the indications and possible complications of this method. MATERIALS AND METHODS: Sixty-two patients with mandibular fractures, treated by intermaxillary fixation using these screws, were evaluated by preoperative and postoperative panoramic radiographs. Clinical testing was carried out for vitality and abnormal mobility of teeth adjacent to the site of screw insertions. To evaluate the efficacy of this method, different factors were considered such as possible iatrogenic dental injuries, loss, breakage or screw cover by oral mucosa and postoperative occlusion. RESULTS: The most important complication was iatrogenic damage to dental roots (1.5%), 4.9% of the screws were covered by oral mucosa and 1.9% were lost, while none were broken. Malocclusion was observed in one patient (1.6%) and lack of consolidation of a displaced fracture of the mandibular body in another patient. CONCLUSIONS: Use of intraoral cortical bone screws for intermaxillary fixation is a valid alternative to arch bars in the treatment of mandibular fractures. Iatrogenic injury to dental roots is the most important problem of this procedure, but can be minimized by an experienced surgeon.

Adolescent↗

[Osteosynthesis with bone screws in closed oblique and screw-like fractures of the long tubular bones].

295 patients subjected to screw osteosynthesis for closed oblique and screw-shape fractures of crural, brachial and antebrachial bones were under observation. The use of screws of a cylindrical form with a somewhat conus-like head and deep slit seems to be most rational for osteosynthesis. To apply screws properly two drills should be available. One should be equal to the diameter of a screw, the other-0.5 mm less. Following screw ostenosynthesis an adequate plaster dressing is applied for 2-3 months. The results of the treatment were good in 280 patients (95%) and poor-in 15 patients (5%). The causes of failure were as follows: improper indications to screw osteosynthesis, an early cessation of immobilization of an extremity in a plaster dressing, and too early loading on the extremity.

Adolescent↗

Biomechanical comparison of cannulated small bone screws: a brief follow-up study.

The compressive forces generated by the ASIF and Herbert small bone cannulated screws were measured in the laboratory with the use of simulated bones and a custom-designed load washer as a means of quantifying their fixation capabilities. Comparative data were also generated for the Herbert scaphoid bone screw and the ASIF 4 mm cancellous screw. The cannulated Herbert bone screw and the ASIF 4 mm cancellous screw were found to have nearly identical compression capabilities. Both generated compression forces approximately five times those of the Herbert scaphoid bone screw. The ASIF small cannulated screw demonstrated a compressive capacity 2 1/2 times that of the Herbert screw.

Biomechanical Phenomena↗